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Danusa KT, Debelo BT, Wakgari N, Seifu B, Kenasa K, Daba G, Wondimu F, Berhanu K. Predictors of Maternal Near Miss in Public Hospitals of West Shoa Zone, Central Ethiopia: A Case-Control Study. Front Med (Lausanne) 2022; 9:868992. [PMID: 35573000 PMCID: PMC9100678 DOI: 10.3389/fmed.2022.868992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/31/2022] [Indexed: 12/04/2022] Open
Abstract
Background Maternal mortality reduction remains a priority to ensure healthy lives and promote wellbeing for mothers and newborns in the new sustainable development goals agenda. There is no evidence-based study done regarding maternal complications and near-miss in the study area. Objectives This study assessed the predictors of maternal near-miss in public hospitals of West Shoa Zone, Central Ethiopia, 2020. Methods An unmatched case-control study was conducted among 664 (166 cases and 498 controls) women who gave birth in public institutions in the West Shewa zone. Structured questionnaires and checklists were used to collect the data. Bivariate, multivariable logistic regression, and adjusted odds ratios were used to describe the strength and directions of association. Results The odds of maternal near-miss were higher among mothers with increased maternal age [Adjusted odds ratio (AOR) = 1.065, 95%CI: (1.015–1.117)], who could not read and write (AOR = 3.06, 95%CI: 1.314–7.135), had primary (AOR = 3.49, 95%CI: 1.518–8.044), and secondary (AOR = 3.213, 95%CI: 1.418–7.282), had no antenatal care (ANC) follow-up (AOR = 2.25, 95%CI: 1.100–4.607), mothers who had a first delay of more than 6 h [AOR = 2.38, 95%CI: (1.517–3.735)] and the distance from health facility of > 60 min [AOR = 4.021, 95%CI: (1.817–8.896)]. Conclusion In this study, delay in decision making and reaching the health facility, lower educational status, not having ANC follow-up, and increased maternal age were significantly associated with maternal near misses. Therefore, the Ethiopian federal ministry of health and other stakeholders should work on increasing ANC coverage, awareness creation, and strong means of transportation to tackle the complications of a maternal near miss.
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Firoz T, Trigo Romero CL, Leung C, Souza JP, Tunçalp Ö. Global and regional estimates of maternal near miss: a systematic review, meta-analysis and experiences with application. BMJ Glob Health 2022; 7:bmjgh-2021-007077. [PMID: 35387768 PMCID: PMC8987675 DOI: 10.1136/bmjgh-2021-007077] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/17/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Maternal near miss (MNM) is a useful means to examine quality of obstetric care. Since the introduction of the WHO MNM criteria in 2011, it has been tested and validated, and is being used globally. We sought to systematically review all available studies using the WHO MNM criteria to develop global and regional estimates of MNM frequency and examine its application across settings. Methods We conducted a systematic review by implementing a comprehensive literature search from 2011 to 2018 in six databases with no language restrictions. The predefined data collection tool included sections on study characteristics, frequency of near-miss cases and study quality. Meta-analysis was performed by regional groupings. Reported adaptations, modifications and remarks about application were extracted. Results 7292 articles were screened by title and abstract, and 264 articles were retrieved for full text review for the meta-analysis. An additional 230 articles were screened for experiences with application of the WHO MNM criteria. Sixty studies with near-miss data from 56 countries were included in the meta-analysis. The pooled global near-miss estimate was 1.4% (95% CI 0.4% to 2.5%) with regional variation in MNM frequency. Of the 20 studies that made adaptations to the criteria, 19 were from low-resource settings where lab-based criteria were adapted due to resource limitations. Conclusions The WHO MNM criteria have enabled the comparison of global and sub-national estimates of MNM frequency. There has been good uptake in low-resource countries but contextual adaptations are necessary.
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Affiliation(s)
- Tabassum Firoz
- Yale New Haven Health, Bridgeport Hospital, Bridgeport, Connecticut, USA
| | - Carla Lionela Trigo Romero
- Department of Social Medicine, University of Sao Paulo Faculty of Medicine of Ribeirao Preto, Ribeirao Preto, Brazil
| | - Clarus Leung
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - João Paulo Souza
- Department of Social Medicine, University of Sao Paulo Faculty of Medicine of Ribeirao Preto, Ribeirao Preto, Brazil
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Jayaratnam S, Franklin R, de Costa C. A scoping review of maternal near miss assessment in Australia, New Zealand, South-East Asia and the South Pacific region: How, what, why and where to? Aust N Z J Obstet Gynaecol 2021; 62:198-213. [PMID: 34791649 DOI: 10.1111/ajo.13457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/05/2021] [Accepted: 10/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Severe maternal morbidity or maternal near miss (MNM) events can have significant consequences for individuals, their families and society and the study of these events may inform practices to reduce future adverse pregnancy outcomes. AIMS To review the scope of MNM studies undertaken in Australia, New Zealand, South-East Asia and the South Pacific region. MATERIALS AND METHODS A systematic search of four online databases (MEDLINE, EMBASE, SCOPUS and CINAHL) and the World Health Organization Library was conducted to identify all relevant studies published between 1 January 2011 and 31 December 2020. The studies were reviewed and included if they assessed MNM using a composite outcome or a predefined set of indicators. RESULTS The literature search yielded 143 articles of which 49 are included in this review. There were substantial differences in the monitoring approach to MNM in the Australasian region. Overall rates of MNM in the region ranged from two to 100/1000 births and the most common aetiologies identified were direct obstetric causes such as postpartum haemorrhage, pre-eclampsia and sepsis. Multidisciplinary review indicated a substantial number of MNM cases were preventable or amenable to improved management, mostly from a provider perspective. CONCLUSIONS Assessment of MNM is an important part of the evaluation of maternity care provision. Reaching a consensus on indicators and how best to collect information will allow a more discerning assessment of MNM including longer-term health outcomes, aspects of preventability and financial implications for health services.
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Affiliation(s)
- Skandarupan Jayaratnam
- Mater Mothers' Hospital, Brisbane, Queensland, Australia.,JCU College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Richard Franklin
- College of Public Health, Medical and Vet Sciences, James Cook University, Townsville, Queensland, Australia
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Jayaratnam S, Jacob-Rodgers S, de Costa C. Characteristics and preventability of obstetric intensive care unit admissions in Far North Queensland. Aust N Z J Obstet Gynaecol 2020; 60:871-876. [PMID: 32557552 DOI: 10.1111/ajo.13198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 05/10/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The rarity of maternal deaths in developed countries has increased interest in auditing cases of severe maternal morbidity or maternal 'near miss'. The assessment and preventability of cases of maternal 'near misses' are important in improving the provision of maternity care. AIMS To describe the epidemiology and determine aspects of preventability in care among women admitted to an obstetric intensive care unit (ICU) in Far North Queensland. MATERIALS AND METHODS A retrospective observational study of pregnant and postpartum patients admitted to the Cairns Hospital ICU between 1 January 2013 and 31 December 2017 was undertaken. Cases of severe maternal morbidity were identified using the World Health Organization (WHO) 'near miss' criteria and reviewed to determine reasons for admission to ICU and ascertain aspects of preventability in the care provided. RESULTS Sixty-nine out of 12 081 (0.6%) women admitted for obstetric care were transferred to the ICU with 31 cases fulfilling WHO 'near miss' criteria. The most common direct obstetric-related diagnosis for ICU admission was hypertensive disease of pregnancy and obstetric haemorrhage. Indirect obstetric causes contributed to approximately 40% of ICU admissions. Among the 31 cases of WHO 'near miss', ten cases were deemed preventable with the most common reason for preventability related to lack of recognition of high-risk clinical status. CONCLUSION Maternal 'near miss' and rates of obstetric admission to the ICU at Cairns Hospital are reassuringly low. Nevertheless, one-third of women with 'near miss' required improvements in the provision of care, emphasising the need for continued audit and improvement of clinical practice.
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Affiliation(s)
- Skandarupan Jayaratnam
- College of Medicine and Dentistry, Cairns Clinical School, James Cook University, Cairns, Queensland, Australia.,Women's Health Unit, Cairns Hospital, Cairns, Queensland, Australia
| | | | - Caroline de Costa
- College of Medicine and Dentistry, Cairns Clinical School, James Cook University, Cairns, Queensland, Australia
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García-Tizón Larroca S, Amor Valera F, Ayuso Herrera E, Cueto Hernandez I, Cuñarro Lopez Y, De Leon-Luis J. Human Development Index of the maternal country of origin and its relationship with maternal near miss: A systematic review of the literature. BMC Pregnancy Childbirth 2020; 20:224. [PMID: 32299375 PMCID: PMC7164222 DOI: 10.1186/s12884-020-02901-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 03/27/2020] [Indexed: 01/09/2023] Open
Abstract
Background The reduction in maternal mortality worldwide has increased the interest in studying more frequent severe events such as maternal near miss. The Human Development Index is a sociodemographic country-specific variable that includes key human development indicators such as living a long and healthy life, acquiring knowledge, and enjoying a decent standard of living, allowing differentiation between countries. In a globalised environment, it is necessary to study whether the Human Development Index of each patient's country of origin can be associated with the maternal near-miss rate and thus classify the risk of maternal morbidity and mortality. Methods A systematic review of the literature published between 2008 and 2019 was conducted, including all articles that reported data about maternal near miss in their sample of pregnant women, in addition to describing the study countries of their sample population. The Human Development Index of the study country, the maternal near-miss rate, the maternal mortality rate, and other maternal-perinatal variables related to morbidity and mortality were used. Results After the systematic review, eighty two articles from over thirty countries were included, for a total of 3,699,697 live births, 37,191 near miss cases, and 4029 mortality cases. A statistically significant (p <0.05) inversely proportional relationship was observed between the Human Development Index of the study country and the maternal near-miss and mortality rates. The most common cause of maternal near miss was haemorrhage, with an overall rate of 38.5%, followed by hypertensive disorders of pregnancy (34.2%), sepsis (7.5%), and other undefined causes (20.9%). Conclusions The Human Development Index of the maternal country of origin is a sociodemographic variable allowing differentiation and classification of the risk of maternal mortality and near miss in pregnant women. The most common cause of maternal near miss published in the literature was haemorrhage. Trial registration PROSPERO ID: CRD 42019133464
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Affiliation(s)
- Santiago García-Tizón Larroca
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain.
| | - Francisco Amor Valera
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Esther Ayuso Herrera
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Ignacio Cueto Hernandez
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Yolanda Cuñarro Lopez
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Juan De Leon-Luis
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain.,Department of Public and Maternal-Infant Health, Complutense University, Madrid, Spain
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Turi E, Fekadu G, Taye B, Kejela G, Desalegn M, Mosisa G, Etafa W, Tsegaye R, Simegnew D, Tilahun T. The impact of antenatal care on maternal near-miss events in Ethiopia: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2020.100246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Duke GJ, Maiden MJ, Huning EYS, Crozier TM, Bilgrami I, Ghanpur RB. Severe acute maternal morbidity trends in Victoria, 2001-2017. Aust N Z J Obstet Gynaecol 2019; 60:548-554. [PMID: 31788786 DOI: 10.1111/ajo.13103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/16/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The incidence of severe acute maternal morbidity (SAMM) is one method of measuring the complexity of maternal health and monitoring maternal outcomes. Monitoring trends may provide a quantitative method for assessing health care at local, regional, or jurisdictional levels and identify issues for further investigation. AIMS Identify temporal trends for SAMM event rates and maternal outcomes over 17 years in the state of Victoria, Australia. MATERIALS AND METHODS All maternal public health service admissions were extracted from an administrative dataset from July 2000 to June 2017. SAMM-related diagnoses were defined by matching as closely as possible with published definitions. Outcomes included annual SAMM event rates, hospital survival, and hospital length of stay (LOS). Temporal trends were analysed using mixed-effects generalised linear models. RESULTS There were 854 777 live births and 1.21 million pregnancy-related hospital admissions which included 34 008 SAMM events in 29 273 records and in 3.42% (95%CI = 3.39-3.46) of births. Most common were severe pre-eclampsia (0.87% of births), severe postpartum haemorrhage (0.59%), and sepsis (0.62%). SAMM-related admissions were associated with longer LOS and higher mortality risk (P < 0.001). Maternal mortality ratio remained unchanged at 8.6 fatalities per 100 000 births (P = 0.65). CONCLUSION Over 17 years, there was a significant increase in birth rate and SAMM-related events in Victoria. Administrative data may provide a pragmatic approach for monitoring SAMM-related events in maternal health services.
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Affiliation(s)
- Graeme J Duke
- Eastern Health Intensive Care Service, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Matthew J Maiden
- Intensive Care Department, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.,Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Emily Y S Huning
- Obstetrics & Gynaecology Service, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Tim M Crozier
- Intensive Care Department, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Irma Bilgrami
- Intensive Care Department, Western Health, Melbourne, Victoria, Australia
| | - Rashmi B Ghanpur
- Intensive Care Department, Warringal Hospital, Melbourne, Victoria, Australia
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Jayaratnam S, Soares MLDFG, Jennings B, Thapa AP, Woods C. Maternal mortality and 'near miss' morbidity at a tertiary hospital in Timor-Leste. Aust N Z J Obstet Gynaecol 2019; 59:567-572. [PMID: 30663049 DOI: 10.1111/ajo.12940] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/30/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Assessment of severe maternal morbidity is increasingly being undertaken to understand the aetiology and factors which lead to adverse maternal outcomes. Their use in conjunction with maternal deaths may allow a comprehensive assessment of care provided, highlight areas for improvement within the health system and allow benchmarking of care against other institutions. Timor-Leste has one of the highest rates of maternal mortality in the Asia-Pacific region; however, there has been limited research into the level of severe obstetric morbidity in the country. AIM To determine the aetiology and rates of severe obstetric morbidity and mortality at Hospital Nacional Guido Valadares, Timor-Leste. METHODS AND MATERIALS Cases of maternal 'near misses' and deaths were prospectively identified over a period of 12 months using the World Health Organization maternal near-miss criteria. Cases of maternal death and near miss were combined (severe maternal outcomes) for descriptive analysis. RESULTS During the audit period, 69 severe maternal outcomes were identified: 30 maternal deaths and 39 'near misses'. The maternal mortality ratio and the maternal near-miss ratio were 662/100 000 live births and 8/1000 live births, respectively. The main identified obstetric aetiologies were haemorrhage and pre-eclampsia, while 22% of severe maternal outcomes did not have a clearly identified cause. CONCLUSION The high institutional maternal mortality ratio requires urgent attention and identification of areas for improvement. Auditing and benchmarking using the WHO near-miss criteria provide a mechanism for standardised comparison of obstetric care but require further refinement to the local context.
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Affiliation(s)
- Skandarupan Jayaratnam
- Department of Obstetrics and Gynaecology, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | | | - Belinda Jennings
- St John of God, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | | | - Cindy Woods
- School of Health, University of New England, Armidale, New South Wales, Australia
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Geller SE, Koch AR, Garland CE, MacDonald EJ, Storey F, Lawton B. A global view of severe maternal morbidity: moving beyond maternal mortality. Reprod Health 2018; 15:98. [PMID: 29945657 PMCID: PMC6019990 DOI: 10.1186/s12978-018-0527-2] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal mortality continues to be of great public health importance, however for each woman who dies as the direct or indirect result of pregnancy, many more women experience life-threatening complications. The global burden of severe maternal morbidity (SMM) is not known, but the World Bank estimates that it is increasing over time. Consistent with rates of maternal mortality, SMM rates are higher in low- and middle-income countries (LMICs) than in high-income countries (HICs). SEVERE MATERNAL MORBIDITY IN HIGH-INCOME COUNTRIES Since the WHO recommended that HICs with low maternal mortality ratios begin to examine SMM to identify systems failures and intervention priorities, researchers in many HICs have turned their attention to SMM. Where surveillance has been conducted, the most common etiologies of SMM have been major obstetric hemorrhage and hypertensive disorders. Of the countries that have conducted SMM reviews, the most common preventable factors were provider-related, specifically failure to identify "high risk" status, delays in diagnosis, and delays in treatment. SEVERE MATERNAL MORBIDITY IN LOW AND MIDDLE INCOME COUNTRIES The highest burden of SMM is in Sub-Saharan Africa, where estimates of SMM are as high as 198 per 1000 live births. Hemorrhage and hypertensive disorders are the leading conditions contributing to SMM across all regions. Case reviews are rare, but have revealed patterns of substandard maternal health care and suboptimal use of evidence-based strategies to prevent and treat morbidity. EFFECTS OF SMM ON DELIVERY OUTCOMES AND INFANTS Severe maternal morbidity not only puts the woman's life at risk, her fetus/neonate may suffer consequences of morbidity and mortality as well. Adverse delivery outcomes occur at a higher frequency among women with SMM. Reducing preventable severe maternal morbidity not only reduces the potential for maternal mortality but also improves the health and well-being of the newborn. CONCLUSION Increasing global maternal morbidity is a failure to achieve broad public health goals of improved women's and infants' health. It is incumbent upon all countries to implement surveillance initiatives to understand the burden of severe morbidity and to implement review processes for assessing potential preventability.
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Affiliation(s)
- Stacie E. Geller
- Departments of Obstetrics & Gynecology and Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL USA
- Center for Research on Women and Gender, University of Illinois at Chicago College of Medicine, Chicago, IL USA
| | - Abigail R. Koch
- Center for Research on Women and Gender, University of Illinois at Chicago College of Medicine, Chicago, IL USA
| | - Caitlin E. Garland
- Center for Research on Women and Gender, University of Illinois at Chicago College of Medicine, Chicago, IL USA
| | - E. Jane MacDonald
- Centre for Women’s Health Research, Victoria University of Wellington, Wellington, New Zealand
| | - Francesca Storey
- Centre for Women’s Health Research, Victoria University of Wellington, Wellington, New Zealand
| | - Beverley Lawton
- Centre for Women’s Health Research, Victoria University of Wellington, Wellington, New Zealand
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Jayaratnam S, Kua S, deCosta C, Franklin R. Maternal 'near miss' collection at an Australian tertiary maternity hospital. BMC Pregnancy Childbirth 2018; 18:221. [PMID: 29890966 PMCID: PMC5996518 DOI: 10.1186/s12884-018-1862-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 05/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Australia has a maternal mortality ratio of 6.8/100000 live births, a rate akin to other developed countries and consistent with the high level care provided within the Australian health care system. With maternal mortality at very low levels assessment of severe maternal morbidity is increasingly being used as an indicator of quality of care and to identify areas for improvement in maternity services. The WHO maternal ‘near miss’ criteria is a standardised tool has been increasingly used worldwide to assess maternal morbidity and standards of maternity care. The aim of this study was to determine the rate and aetiology of maternal ‘near misses’ at King Edward Memorial Hospital (KEMH) using the WHO near miss criteria. Methods Cases of maternal ‘near miss’ were prospectively identified at KEMH using the WHO near miss criteria over a period of 6 months (1st December 2014 to 31st May 2015). A descriptive analysis of the results was undertaken. Results During the study there were 2773 live births with 19 women who had ‘near miss’ presentations. There were no maternal deaths. The maternal ‘near miss’ index rate was 7/1000 live births. The main causes of obstetric ‘near miss’ were obstetric haemorrhage, pre-eclampsia and early pregnancy complications. Conclusion The rate of maternal ‘near miss’ at KEMH was 7/1000 live births and post-partum haemorrhage was identified as the most common aetiology, consistent with other studies in developed countries. Further research comparing currently utilised local, state and national morbidity systems would allow further validation of the WHO near miss criteria in Australian settings. The study presented in this publication was undertaken at King Edward Memorial Hospital, 374 Bagot Rd., Subiaco WA 6008. Electronic supplementary material The online version of this article (10.1186/s12884-018-1862-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Sonia Kua
- King Edward Memorial Hospital, Perth, WA, Australia
| | - Caroline deCosta
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - Richard Franklin
- College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, QLD, Australia
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Akrawi VS, Al-Hadithi TS, Al-Tawil NG. Major Determinants of Maternal Near-Miss and Mortality at the Maternity Teaching Hospital, Erbil city, Iraq. Oman Med J 2017; 32:386-395. [PMID: 29026470 PMCID: PMC5632696 DOI: 10.5001/omj.2017.74] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/29/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To find out the major determinants of maternal near-miss (NM)and maternal deaths (MDs) in Erbil city, Iraq, by comparative analysis of maternal NMs and MDs. METHODS We conducted a hospital-based cross-sectional study in the Maternity Teaching Hospital in Erbil city from 1 June to 31 December 2013. All MDs and NMs that occurred in the hospital during the study period were included in the study. Systematic identification of all eligible women was done. This identification included a baseline assessment of the severe pregnancy-related complications using the World Health Organization NM criteria. RESULTS Severe preeclampsia and postpartum hemorrhage (PPH) constituted the highest proportions of complications in women with potentially life-threatening conditions (PLTCs) (30.5% and 30.0%, respectively). The highest mortality indexes were those for ruptured uterus (16.7) and severe complications of placenta previa (14.2). Factors that were significantly associated with MD (compared to NM) were hepatic dysfunction (p = 0.046), multiple/unspecified disorders (p = 0.003), arrival as an emergency condition by ambulance (p = 0.015), and history of previous cesarean section (p = 0.013). CONCLUSIONS Severe preeclampsia and PPH are the main complications that lead to PLTCs. Factors found to be associated with MDs are hepatic dysfunction, multiple/unspecified disorders, arrival as an emergency condition by ambulance, and history of a previous cesarean section.
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Liyew EF, Yalew AW, Afework MF, Essén B. Incidence and causes of maternal near-miss in selected hospitals of Addis Ababa, Ethiopia. PLoS One 2017; 12:e0179013. [PMID: 28586355 PMCID: PMC5460898 DOI: 10.1371/journal.pone.0179013] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 05/23/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Because maternal mortality is a rare event, it is important to study maternal near-miss as a complement to evaluate and improve the quality of obstetric care. Thus, the study was conducted with the aim of assessing the incidence and causes of maternal near-miss. METHODS A facility-based cross-sectional study was conducted in five selected public hospitals of Addis Ababa, Ethiopia from May 1, 2015 to April 30, 2016. All maternal near-miss cases admitted to the selected hospitals during the study period were prospectively recruited. World Health Organization criteria were used to identify maternal near-miss cases. The number of maternal near-miss cases over one year per 1000 live births occurring during the same year was calculated to determine the incidence of maternal near-miss. Underlying and contributing causes of maternal near-miss were documented from each participant's record. RESULTS During the one-year period, there were a total of 238 maternal near-miss cases and 29,697 live births in all participating hospitals, which provides a maternal near-miss incidence ratio of 8.01 per 1000 live births. The underlying causes of the majority of maternal near-miss cases were hypertensive disorders and obstetric hemorrhage. Anemia was the major contributing cause reported for maternal near-miss. Most of the maternal near-miss cases occurred before the women's arrival at the participating hospitals. CONCLUSION The study demonstrated a lower maternal near-miss incidence ratio compared to previous country-level studies. The majority of the near-miss cases occurred before the women's arrival at the participating hospitals, which underscores the importance of improving pre-hospital barriers. Efforts made toward improvement in the management of life-threatening obstetric complications could reduce the occurrence of maternal near-miss problems that occur during hospitalization.
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Affiliation(s)
- Ewnetu Firdawek Liyew
- Department of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Alemayehu Worku Yalew
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mesganaw Fantahun Afework
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Birgitta Essén
- Department of Women’s and Children’s Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
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A systematic review of maternal near miss and mortality due to postpartum hemorrhage. Int J Gynaecol Obstet 2017; 137:1-7. [DOI: 10.1002/ijgo.12096] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/09/2016] [Accepted: 01/04/2017] [Indexed: 11/07/2022]
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Kingwell EL, Butt J, Leslie G. Maternity high-dependency care and the Australian midwife: A review of the literature. Women Birth 2016; 30:e73-e77. [PMID: 27865818 DOI: 10.1016/j.wombi.2016.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 07/07/2016] [Accepted: 10/17/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Maternity high-dependency care has emerged throughout the 21st century in Australian maternity hospitals as a distinct sub-speciality of maternity care. However, what the care involves, how and why it should be provided, and the role of midwives in the provision of such care remains highly variable. INTRODUCTION Rising levels of maternal morbidity from non-obstetric causes have led midwives to work with women who require highly complex care, beyond the standard customary midwifery role. Whilst the nursing profession has developed and refined its expertise as a specialty in the field of high-dependency care, the midwifery profession has been less likely to pursue this as a specific area of practice. DISCUSSION This paper explores the literature surrounding maternity high-dependency care. From the articles reviewed, four key themes emerge which include; the need for maternity high-dependency care, maternal morbidity and maternity high-dependency care, the role of the midwife and maternity high-dependency care and midwifery education and preparation for practice. It highlights the challenges that health services are faced with in order to provide maternity high-dependency care to women. Some of these challenges include resourcing and budgeting limitations, availability of educators with the expertise to train staff, and the availability of suitably trained staff to care for the women when required. CONCLUSION In order to provide maternity high-dependency care, midwives need to be suitably equipped with the knowledge and skills required to do so.
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Affiliation(s)
- Emma L Kingwell
- King Edward Hospital for Women, Department of Nursing and Midwifery Education and Research, 374 Bagot Rd. Subiaco, 6008 Perth, Australia; Curtin University, School of Nursing, Midwifery and Paramedicine, Kent Street Bentley, 6845, Australia.
| | - Janice Butt
- King Edward Hospital for Women, Department of Nursing and Midwifery Education and Research, 374 Bagot Rd. Subiaco, 6008 Perth, Australia; Curtin University, School of Nursing, Midwifery and Paramedicine, Kent Street Bentley, 6845, Australia
| | - Gavin Leslie
- Curtin University, School of Nursing, Midwifery and Paramedicine, Kent Street Bentley, 6845, Australia
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Jayaratnam S, Burton A, Connan KF, de Costa C. Maternal 'near miss' at Royal Darwin Hospital: An analysis of severe maternal morbidity at an Australian regional tertiary maternity unit. Aust N Z J Obstet Gynaecol 2016; 56:381-6. [PMID: 26847161 DOI: 10.1111/ajo.12436] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/06/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Assessment of severe maternal morbidity using World Health Organization (WHO) 'near-miss' criteria is gaining in importance as a valuable tool in the assessment of maternity care of women. Identification of cases allows an understanding of aetiology of severe morbidity and factors contributing to poor maternal outcomes. AIM The aim of this study is to determine the rate of maternal 'near miss' at Royal Darwin Hospital (RDH) and the utility of the WHO near-miss criteria as a tool for data collection in a regional Australian context. METHODS AND MATERIALS Cases of maternal 'near miss' and deaths were prospectively identified over a period of 12 months using the WHO criteria. RESULTS During the audit period, there were 2080 live births at Royal Darwin Hospital (RDH): 10 women presented with a 'near miss' and there was one maternal death. The maternal mortality ratio for the hospital was 48/100 000 live births, the maternal 'near-miss' index ratio was 4.8/1000 live births, and the combination of maternal deaths and near misses gave a severe maternal outcome (SMO) ratio of 5.3/1000 live births. The main cause of obstetric 'near miss' was obstetric haemorrhage. Indigenous women and women from remote areas comprised a significant portion of 'near-miss' cases. CONCLUSION The rates of maternal 'near miss' at RDH are consistent with other studies in the developed world. The WHO maternal 'near-miss' audit tool helps health professionals understand and anticipate severe maternal morbidities, with the aim of improving maternal and perinatal outcomes.
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Affiliation(s)
- Skandarupan Jayaratnam
- Royal Darwin Hospital, Darwin, NT, Australia.,Hospital Nacional Guido Valadares (HNGV), Dili, Timor-Leste
| | - Alice Burton
- Royal Darwin Hospital, Darwin, NT, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Kirsten Fiona Connan
- Royal Darwin Hospital, Darwin, NT, Australia.,Tasmanian Obstetrics and Gynaecology Specialists - TasOGS, Hobart, TAS, Australia
| | - Caroline de Costa
- Department of Medicine and Dentistry, James Cook University (JCU), Cairns, Qld, Australia
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Tanimia H, Jayaratnam S, Mola GL, Amoa AB, de Costa C. Near-misses at the Port Moresby General Hospital: a descriptive study. Aust N Z J Obstet Gynaecol 2016; 56:148-53. [PMID: 26840600 DOI: 10.1111/ajo.12430] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/21/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The World Health Organization (WHO) defines 'maternal near-miss' as 'a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of her pregnancy'. With declining rates of maternal mortality, near-miss analysis is being examined in both developed and developing country settings for the assessment of obstetric care. AIMS Over a 15-month period, details of cases that could be classified as 'near-misses' were collected at Port Moresby General Hospital (PMGH), to assess the practicality of collecting such data routinely and determine near-miss rates for the hospital. MATERIALS AND METHODS Information about all cases that fitted the WHO definition of 'near-miss' was collected prospectively. RESULTS During the audit period, there were 13 338 live births at PMGH; 131 women presented with a life-threatening condition of whom 122 met WHO criteria for 'maternal near-miss'; there were nine maternal deaths. The maternal mortality ratio was 67.5/100 000 live births, the maternal near-miss index ratio 9.1/1000 live births and the combination of maternal deaths and near-misses gave a severe maternal outcome ratio of 9.8/1000 live births. Main causes of the 'near-misses' were obstetric haemorrhage, hypertensive disorders and infections. Grandmultiparity, nulliparity, no antenatal attendance and age beyond 30 years were associated with maternal near-misses. CONCLUSION Assessment of near-misses equivalent to that provided in developed countries is possible in less well-resourced settings such as PMGH. Knowledge of causes of near-misses will assist health professionals to anticipate or prevent devastating maternal morbidities and thereby improve maternal and perinatal outcomes.
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Affiliation(s)
- Hilda Tanimia
- Division of Obstetrics and Gynaecology, Port Moresby General Hospital, Boroko, Papua New Guinea
| | | | - Glen L Mola
- Division of Obstetrics and Gynaecology, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Apeawusu B Amoa
- Division of Obstetrics and Gynaecology, Port Moresby General Hospital, Boroko, Papua New Guinea
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Nakimuli A, Nakubulwa S, Kakaire O, Osinde MO, Mbalinda SN, Nabirye RC, Kakande N, Kaye DK. Maternal near misses from two referral hospitals in Uganda: a prospective cohort study on incidence, determinants and prognostic factors. BMC Pregnancy Childbirth 2016; 16:24. [PMID: 26821716 PMCID: PMC4731977 DOI: 10.1186/s12884-016-0811-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 01/21/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Maternal near misses occur more often than maternal deaths and could enable more comprehensive analysis of risk factors, short-term outcomes and prognostic factors of complications during pregnancy and childbirth. The study determined the incidence, determinants and prognostic factors of severe maternal outcomes (near miss or maternal death) in two referral hospitals in Uganda. METHODS A prospective cohort study was conducted between March 1, 2013 and February 28, 2014, where cases of severe pregnancy and childbirth complications were included. The clinical conditions included abortion-related complications, obstetric haemorrhage, hypertensive disorders, obstructed labour, infection and pregnancy-specific complications such as febrile illness, anemia and premature rupture of membranes. Near miss cases were defined according to the WHO criteria. Multivariate logistic regression analysis was conducted to identify prognostic factors for severe maternal outcomes. RESULTS Of 3100 women with severe obstetric complications, 130 (4.2%) were maternal deaths and 695 (22.7%) were near miss cases. Severe pre-eclampsia was the commonest morbidity (incidence ratio (IR) 7.0%, case-fatality rate (CFR) 2.3%), followed by postpartum haemorrhage (IR 6.7%, CFR 7.2%). Uterine rupture (IR 5.5%) caused the highest CFR (17.9%), followed by eclampsia (IR 0.4%, CFR 17.8%). The three groups (maternal deaths, near misses and non-life-threatening obstetric complications) differed significantly regarding gravidity and education level. The commonest diagnostic criteria for maternal near miss were admission to the high dependency unit (HDU) or to the intensive care unit (ICU). Thrombocytopenia, circulatory collapse, referral to a more specialized unit, intubation unrelated to anaesthesia, and cardiopulmonary resuscitation were predictive of maternal death (p < 0.05). Gravidity (ARR 1.4, 95% C1 1.0-1.2); elevated serum lactate levels (ARR 4.5, 95% CI 2.3-8.7); intubation for conditions unrelated to general anaesthesia (ARR 2.6 (95% CI 1.2-5.7), cardiovascular collapse (ARR 4.9, 95% CI 2.5-9.5); transfusion of 4 or more units of blood (ARR 1.9, 95% CI 1.1-3.1); being an emergency referral (ARR 2.6, 95% CI 1.2-5.6); and need for cardiopulmonary resuscitation (ARR 6.1, 95% CI 3.2-11.7), were prognostic factors. CONCLUSIONS The analysis of near misses is a useful tool in the investigation of severe maternal morbidity. The prognostic factors for maternal death, if instituted, might save many women with obstetric complications.
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Affiliation(s)
- Annettee Nakimuli
- />Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Sarah Nakubulwa
- />Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Othman Kakaire
- />Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Michael O. Osinde
- />Department of Obstetrics and Gynecology, Jinja Regional Hospital, Jinja, Uganda
| | - Scovia N. Mbalinda
- />Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Rose C. Nabirye
- />Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Nelson Kakande
- />Clinical, Operations and Health Services Research Program, Joint Clinical Research Centre, P. O. Box 10005, Kampala, Uganda
| | - Dan K. Kaye
- />Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
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Witteveen T, de Koning I, Bezstarosti H, van den Akker T, van Roosmalen J, Bloemenkamp KW. Validating the WHO Maternal Near Miss Tool in a high-income country. Acta Obstet Gynecol Scand 2015; 95:106-11. [PMID: 26456014 DOI: 10.1111/aogs.12793] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 09/19/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study was performed to assess the applicability of the WHO Maternal Near Miss Tool (MNM Tool) and the organ dysfunction criteria in a high-income country. MATERIAL AND METHODS The MNM tool was applied to 2552 women who died of pregnancy-related causes or sustained severe acute maternal morbidity between August 2004 and August 2006 in one of the 98 hospitals with a maternity unit in the Netherlands. Fourteen (0.6%) cases had insufficient data for application. Each case was assessed according to the three main "MNM categories" specified in the MNM tool and their subcategory criteria: five disease-, four intervention- and seven organ dysfunction-based criteria. Potentially life-threatening conditions (disease-based inclusions) and life-threatening cases (organ dysfunction-based inclusions) were differentiated according to WHO methodology. Outcomes were incidence of all (sub)categories and case-fatality rates. RESULTS Of the 2538 cases, 2308 (90.9%) women fulfilled disease-based, 2116 (83.4%) intervention-based and 1024 (40.3%) organ dysfunction-based criteria. Maternal death occurred in 48 women, of whom 23 (47.9%) fulfilled disease-based, 33 (68.8%) intervention-based and 31 (64.6%) organ dysfunction-based criteria. Case-fatality rates were 23/2308 (1.0%) for cases fulfilling the disease-based criteria, 33/2116 (1.6%) for intervention-based criteria and 31/1024 (3.0%) for women fulfilling the organ dysfunction-based criteria. CONCLUSIONS In the Netherlands, where advanced laboratory and clinical monitoring are available, organ dysfunction-based criteria of the MNM tool failed to identify nearly two-thirds of sustained severe acute maternal morbidity cases and more than one-third of maternal deaths. Disease-based criteria remain important, and using only organ dysfunction-based criteria would lead to underestimating severe acute maternal morbidity.
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Affiliation(s)
- Tom Witteveen
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Ilona de Koning
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Bezstarosti
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jos van Roosmalen
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.,Athena Institute, VU University Amsterdam, Amsterdam, the Netherlands
| | - Kitty W Bloemenkamp
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
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Dias MAB, Domingues RMSM, Schilithz AOC, Nakamura-Pereira M, Diniz CSG, Brum IR, Martins AL, Theme Filha MM, Gama SGND, Carmo Leal MD. Incidence of maternal near miss in hospital childbirth and postpartum: data from the Birth in Brazil study. CAD SAUDE PUBLICA 2015; 30 Suppl 1:S1-12. [PMID: 25167176 DOI: 10.1590/0102-311x00154213] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 02/05/2014] [Indexed: 11/22/2022] Open
Abstract
This study evaluated data on the incidence of maternal near miss identified on World Health Organization (WHO) criteria from the Birth in Brazil survey. The study was conducted between February 2011 and October 2012. The results presented are estimates for the study population (2,337,476 births), based on a sample of 23,894 women interviewed. The results showed an incidence of maternal near miss of 10.21 per 1,000 live births and a near-miss-to-mortality ratio of 30.8 maternal near miss to every maternal death. Maternal near miss was identified most prevalently by clinical criteria, at incidence of 5.2 per 1,000 live births. Maternal near miss was associated with maternal age 35 or more years (RR=1.6; 95%CI: 1.1-2.5), a history of previous cesarean delivery (RR=1.9; 95%CI: 1.1-3.4) and high-risk pregnancy (RR=4.5; 95%CI: 2.8-7.0). incidence of maternal near miss was also higher at hospitals in capital cities (RR=2.2; 95%CI: 1.3-3.8) and those belonging to Brazil's national health service, the Brazilian Unified National Health System (SUS) (RR=3.2; 95%CI: 1.6-6.6). Improved quality of childbirth care services can help reduce maternal mortality in Brazil.
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Affiliation(s)
- Marcos Augusto Bastos Dias
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | | | - Marcos Nakamura-Pereira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | | | | | | | | | - Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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"Near miss" obstetric events and maternal deaths in a tertiary care hospital: an audit. J Pregnancy 2013; 2013:393758. [PMID: 23878737 PMCID: PMC3710620 DOI: 10.1155/2013/393758] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 06/11/2013] [Indexed: 11/17/2022] Open
Abstract
Objectives. (1) To determine the frequency of maternal near miss, maternal near miss incidence ratio (MNMR), maternal near miss to mortality ratio and mortality index. (2) To compare the nature of near miss events with that of maternal mortality. (3) To see the trend of near miss events. Design. Audit. Setting. Kasturba Hospital, Manipal University, Manipal, India. Population. Near miss cases & maternal deaths. Methods. Cases were defined based on WHO criteria 2009. Main Outcome Measures. Severe acute maternal morbidity and maternal deaths. Results. There were 7390 deliveries and 131 “near miss” cases during the study period. The Maternal near miss incidence ratio was 17.8/1000 live births, maternal near miss to mortality ratio was 5.6 : 1, and mortality index was 14.9%. A total of 126 cases were referred, while 5 cases were booked at our hospital. Hemorrhage was the leading cause (44.2%), followed by hypertensive disorders (23.6%) and sepsis (16.3%). Maternal mortality ratio (MMR) was 313/100000 live births. Conclusion. Hemorrhage and hypertensive disorders are the leading causes of near miss events. New-onset viral infections have emerged as the leading cause of maternal mortality. As near miss analysis indicates the quality of health care, it is worth presenting in national indices.
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Current World Literature. Curr Opin Obstet Gynecol 2013. [DOI: 10.1097/gco.0b013e32835f3eec] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lobato G, Nakamura-Pereira M, Mendes-Silva W, Dias MA, Reichenheim ME. Comparing different diagnostic approaches to severe maternal morbidity and near-miss: a pilot study in a Brazilian tertiary hospital. Eur J Obstet Gynecol Reprod Biol 2013. [DOI: 10.1016/j.ejogrb.2012.10.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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L Barrett H, Devin R, Clarke S, Dekker Nitert M, Boots R, Fagermo N, K Callaway L, Lust K. A fifteen-year retrospective review of obstetric patients requiring critical care. Obstet Med 2012; 5:166-170. [PMID: 30705698 DOI: 10.1258/om.2012.120033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2012] [Indexed: 11/18/2022] Open
Abstract
Background Maternal mortality is a rare occurrence in developed nations. Given the low maternal mortality rate, other markers must be used to assess maternal risk and quality of obstetric care. One such is admission to critical care. Aims To determine the rate of admission, diagnosis and management of women from conception and up to 6 weeks postpartum to critical care units including coronary care (CCU), high dependency unit (HDU) and intensive care units (ICU). Methods We performed a retrospective review of obstetric patients requiring critical care admission from January 1995 to August 2010. Demographic details, obstetric history, place of admission (CCU, HDU or ICU) and fetal/neonatal outcomes were examined as were initial indication for critical care admission, final diagnosis and treatment administered. Results Data were available from 308 admission incidents. There were 259 (84%) admissions to ICU and 49 (15.9%) to CCU. More than a third of women were transferred from another institution. Those women transferred were more unwell and had a higher mortality rate than local women. Primary diagnoses: obstetric haemorrhage (ICU 30.9%), hypertensive disorders of pregnancy (ICU 16.2%, CCU 12.2%), infection (ICU 14.2%, CCU 6.1%), pre-existing cardiac disease (ICU 9.3%, CCU 55.1%). Conclusions The obstetric population represents only a small percentage of critical care utilisation and overall morbidity and mortality. However, this population is an important and growing group. Increased surveillance peripartum in a critical care facility allows earlier detection of maternal compromise and detailed management. Analysis of these 'near misses' in obstetrics aims to improve pregnancy outcomes.
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Affiliation(s)
- Helen L Barrett
- Internal Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,School of Medicine, University of Queensland, Herston, QLD, 4029, Australia.,UQ Center for Clinical Research, University of Queensland, Herston, QLD, 4029, Australia
| | - Ruth Devin
- Internal Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Sophie Clarke
- Internal Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Marloes Dekker Nitert
- School of Medicine, University of Queensland, Herston, QLD, 4029, Australia.,UQ Center for Clinical Research, University of Queensland, Herston, QLD, 4029, Australia
| | - Robert Boots
- Intensive Care, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Narelle Fagermo
- Internal Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,School of Medicine, University of Queensland, Herston, QLD, 4029, Australia
| | - Leonie K Callaway
- Internal Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,School of Medicine, University of Queensland, Herston, QLD, 4029, Australia
| | - Karin Lust
- Internal Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,School of Medicine, University of Queensland, Herston, QLD, 4029, Australia
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Ghazal-Aswad S, Badrinath P, Sidky I, Safi TH, Gargash H, Abdul-Razak Y, Mirghani H. Severe Acute Maternal Morbidity in a High-Income Developing Multiethnic Country. Matern Child Health J 2012; 17:399-404. [DOI: 10.1007/s10995-012-0984-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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